Bitopic muscarinic agonists and antagonists and methods of synthesis and use thereof

ABSTRACT

The present invention is directed to a composition comprising the following compound: 
     
       
         
         
             
             
         
       
     
     The compound is associated with activity of a muscarinic receptor (e.g. one or more M 1 , M 2 , M 3 , M 4  and M 5 .

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No. 13/937,350, filed Jul. 9, 2013, which claims the benefit of U.S. Provisional Application Ser. No. 61/671,976, filed Jul. 16, 2012, which are hereby incorporated by reference in their entireties, for all purposes, herein.

FIELD OF THE INVENTION

The invention relates generally to the fields of chemistry, molecular biology, and medicine. More particularly, the invention relates to synthesis and use of bitopic muscarinic receptor agonists and antagonists.

BACKGROUND

G-protein-coupled receptors (GPCRs) represent a large protein family responsible for mediating extracellular to intracellular signaling. They are located in the plasma membrane of all cell types of various tissues and are involved in the control of numerous central and peripheral physiological responses, as well as being a major drug target in human disease. This family of receptors consists of muscarinic receptors designated as M₁-M₅. Each receptor is a single subunit membrane protein with seven α-helical transmembrane spanning domains, three extracellular and three intracellular loops which form a pocket for ligand binding. The gene family as a whole has approximately 26% overall amino acid identity. The third loop which selectively couples with G proteins is particularly variable, showing 2.7% identity between receptors compared with an average of 66% identity found in the conserved transmembrane domains. M₂ and M₄ receptors normally couple to the pertusiss-toxin sensitive G_(i)/_(o)-proteins, whereas M₁, M₃ and M₅ receptors couple to G_(q)/₁₁-proteins. Smooth muscle contraction, particularly of airway, ileum, iris and bladder, is mediated primarily by M₃ muscarinic receptors and to a much lesser extent by M₂ receptors. Exocrine secretion, particularly of saliva and insulin, is primarily mediated by M₃ receptors and to a smaller extent by M₁ receptors. M₂ receptors in the heart have a profound role in the control of cardiac myocyte contraction. M₁ receptors have been found to play an important role in memory and learning while M₄ receptors are thought to mediate an inhibitory effect on striatal dopamine-mediated locomotor activity. Additionally, M₂ receptors located in the hypothalamus are likely to be involved in the regulation of body temperature whereas M₃ receptors have been reported to modulate appetite. These muscarinic receptor subtypes thus provide effective therapeutic targets for a number of neurological and psychiatric diseases such as Alzheimer's (AD), Schizophrenia and Parkinson's Disease. Research has focused on the development of selective M₁/M₅ muscarinic agonists and M₂ antagonists as potential therapeutic targets for the symptomatic treatment of AD, M₁/M₄ agonists for Schizophrenia, and M₁/M₄ antagonists for Parkinson's Disease. In addition to central nervous system (CNS) disorders, selective M₂ and M₃ muscarinic antagonists can be beneficial for the treatment of disorders such as chronic obstructive pulmonary disease (COPD), asthma and overactive bladder (OAB) syndrome.

Classical approaches to GPCR drug design have targeted the orthosteric receptor binding site and most drugs are known to interact with this endogenous ligand-binding pocket. Since the orthosteric site is usually conserved across GPCR subtypes, orthosteric ligands must overcome many limitations, such as decreased selectivity, efficacy, and undesirable side effects, thus making the development of subtype-specific agonists and antagonists very difficult. G-protein receptors also contain topographically distinct and less conserved allosteric binding sites that are targeted to attain drug selectivity. Novel drugs that modulate receptor function by targeting these allosteric sites alter the biological properties of the endogenous orthostheric ligand by either changing its affinity and/or efficacy. Allosteric compounds show higher subtype selectivity, have a safer pharmacological profile and often do not induce receptor desensitization. Allosteric modulators have therefore considerable therapeutic potential but their signaling properties are only beginning to be explored. Researchers have begun to explore the potential of linking orthosteric and allosteric pharmacophores to yield bitopic ligands. Bitopic ligands are single molecules with two different structural motifs chemically attached in a manner that allow simultaneous binding to both allosteric and orthosteric sites of the receptor. The goal is to combine high affinity, via orthosteric sites, with high selectivity, via allosteric sites. Bitopic ligands may lead to novel drugs with improved affinity and/or selectivity profiles, and muscarinic acetylcholine receptors (mAChRs).

SUMMARY

Described herein are compositions, methods and kits for treating a condition associated with modulation of a muscarinic receptor (e.g., one or more of M₁, M₂, M₃, M₄, M₅). A bitopic muscarinic antagonist, named JB-D4, was discovered. This bitopic ligand and other structural analogs, as well as bitopic muscarinic agonists, described herein may be used as neuromuscular blocking agents (e.g., for use in compositions for anesthetizing a subject), for the treatment of CNS disorders (e.g., Parkinson's disease, Schizophrenia, etc.), OAB syndrome, COPD, asthma, and many other diseases associated with the activation or inhibition of M₁-M₅ acetylcholine receptors, while providing, due to their bitopic nature, increased selectivity and efficacy compared to currently available therapeutics.

Accordingly, described herein is a composition including a pharmaceutically acceptable carrier and a bitopic muscarinic antagonist or agonist having the formula:

wherein:

-   R₁ is Me, Et, Pr, Bu, pentyl, or hexyl; -   R₂ is H or Me; -   X is C, O, or S;     -   Y is O, S or no group; -   W is C, O, N, or S; -   Z is C, O, or S;     -   n is 1-5 CH₂-group; and m= is 0 or 1; and wherein         the B-ring can be a 5 (m=0) or 6 (m=1)-membered saturated or         unsaturated ring containing one or more double bonds between any         2 carbon atoms and with W═C, O, N, or S at any position, or an         analog or derivative thereof, in a therapeutically effective         amount for activating or inhibiting activation of at least one         muscarinic receptor (e.g., M₁, M₂, M₃, M₄ and M₅), in a subject.         The composition can be formulated, for example, for oral or         intravenous administration

Also described herein is a composition including a pharmaceutically acceptable carrier and a bitopic muscarinic antagonist having the formula:

in a therapeutically effective amount for inhibiting activation of at least one muscarinic receptor (e.g., M₁, M₂, M₃, M₄ and M₅) in a subject. The composition can be formulated, for example, for oral or intravenous administration.

Further described herein is a kit for treating a disease or disorder associated with activity of a muscarinic receptor in a subject (e.g., human). A typical kit includes: a composition as described herein in a therapeutically effective amount for activating or inhibiting activity of at least one muscarinic receptor in the subject and alleviating or eliminating the disease or disorder in the subject; instructions for use; and packaging. The at least one muscarinic receptor can be one or more of, for example, M₁, M₂, M₃, M₄, and M₅ The disease or disorder can be, for example, a central nervous system disorder, overactive bladder syndrome, COPD, and asthma. The central nervous system disorder can be, for example, Parkinson's disease, Schizophrenia, drug addiction or AD. The composition can be formulated, for example, for oral or intravenous administration. In one embodiment of a kit, the bitopic muscarinic antagonist has the formula:

Also described herein is a method of treating a disease or disorder associated with activity of a muscarinic receptor in a subject. The method includes administering to the subject a composition as described herein in a therapeutically effective amount for activating or inhibiting activity of at least one muscarinic receptor in the subject and alleviating or eliminating the disease or disorder in the subject. The subject is typically a human, and the disease or disorder can be, for example, a central nervous system disorder, overactive bladder syndrome, COPD, or asthma. Examples of central nervous system disorders include Parkinson's disease, Schizophrenia, AD, and drug addiction. In the method, the composition can be administered, for example, orally or intravenously. Administration of the composition results in inhibition of activation of at least one muscarinic receptor, e.g., M₁, M₂, M₃, M₄, and M₅. In some embodiments, the bitopic muscarinic antagonist has the formula:

Yet further described herein is a method of anesthetizing a subject. The method includes administering to the subject a composition including a bitopic muscarinic antagonist having the formula:

in an amount effective for inhibiting activation of M₃ and M₄ muscarinic receptors on smooth muscle tissues in the subject. The composition can further include an anesthesia agent. In one embodiment of the method, the composition is administered with a second composition including an anesthesia agent. In such an embodiment, the composition can be administered prior to, simultaneous to, or subsequent to administration of the second composition.

Unless otherwise defined, all technical terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs.

The terms “patient,” “subject” and “individual” are used interchangeably herein, and mean an invertebrate or vertebrate animal (e.g., mammal such as a human, rodent, non-human primate, canine, bovine, ovine, equine, feline, etc.) subject to be treated and/or to obtain a biological sample from. The compositions and methods described herein may find utility in both humans and animals, i.e., will have both medical and veterinary applications for treating a condition, disease or disorder associated with activity of one or more muscarinic receptors.

As used herein, “bind,” “binds,” or “interacts with” means that one molecule recognizes and adheres to a particular second molecule in a sample or organism, but does not substantially recognize or adhere to other structurally unrelated molecules in the sample. Generally, a first molecule that “specifically binds” a second molecule has a binding affinity greater than about 10⁻⁸ to 10⁻¹² moles/liter for that second molecule and involves precise “hand-in-a-glove” docking interactions that can be covalent and noncovalent (hydrogen bonding, hydrophobic, ionic, and van der waals).

As used herein, the terms “regulating”, “regulation”, “modulating” or “modulation” refers to the ability of an agent to either inhibit or enhance or maintain activity and/or function of a molecule (e.g., a receptor). For example, an inhibitor of a muscarinic receptor would down-regulate, decrease, reduce, suppress, or inactivate at least partially the activity and/or function of the receptor. Up-regulation refers to a relative increase in function and/or activity.

By the term “JB-D4” is meant the compound described herein as “Compound A.” This term encompasses the free base, a pharmaceutically acceptable salt or solvate thereof.

As used herein, the term “bitopic” means binding to both allosteric and orthosteric receptor sites simultaneously.

By the phrase “bitopic muscarinic antagonist” is meant any agent (e.g., drug, compound, hormone, etc.) that forms a complex with or binds to receptors on a cell, thereby inhibiting the activity of such receptors.

By the phrase “bitopic muscarinic agonist” is meant any agent (e.g., drug, compound, hormone, etc.) that forms a complex with or binds to receptors on a cell, thereby initiating a physiological response.

The term “sample” is used herein in its broadest sense. A sample including polynucleotides, polypeptides, peptides, antibodies and the like may include a bodily fluid, a soluble fraction of a cell preparation or media in which cells were grown, genomic DNA, RNA or cDNA, a cell, a tissue, skin, hair and the like. Examples of samples include saliva, serum, blood, urine and plasma.

As used herein, the term “treatment” is defined as the application or administration of a therapeutic agent to a patient, or application or administration of the therapeutic agent to an isolated tissue or cell line from a patient, who has a disease, a symptom of disease or a predisposition toward a disease, with the purpose to cure, heal, alleviate, relieve, alter, remedy, ameliorate, improve or affect the disease, the symptoms of disease, or the predisposition toward disease.

As used herein, the phrase “safe and effective amount” refers to the quantity of a component, which is sufficient to yield a desired therapeutic response without undue adverse side effects (such as toxicity, irritation, or allergic response) commensurate with a reasonable benefit/risk ratio when used in the manner of this invention. By “therapeutically effective amount” is meant an amount of a composition of the present invention effective to yield the desired therapeutic response. For example, an amount effective to prevent the occurrence of, delay the progression of, or mitigate the severity of AD, Schizophrenia drug addiction or withdrawal, etc. As another example, an amount effective for inhibiting activation or activity of M₃ and M₄ muscarinic receptors on neuromuscular cells for anesthetizing a subject. The specific safe and effective amount or therapeutically effective amount will vary with such factors as the particular condition being treated, the physical condition of the patient, the type of mammal or animal being treated, the duration of the treatment, the nature of concurrent therapy (if any), and the specific formulations employed and the structure of the compounds or their derivatives.

Although compositions, kits, and methods similar or equivalent to those described herein can be used in the practice or testing of the present invention, suitable compositions, kits, and methods are described below. All publications, patent applications, and patents mentioned herein are incorporated by reference in their entirety. In the case of conflict, the present specification, including definitions, will control. The particular embodiments discussed below are illustrative only and not intended to be limiting.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B show structural analogs of JB-D4 expected to display similar muscarinic bitopic properties (Compounds B-M).

FIG. 2 is a series of graphs showing dissociation of [³H] NMS.

FIG. 3 is a series of graphs showing dissociation of [³H] acetylcholine.

FIG. 4 is a graph showing an NMS binding assay concentration-response curve.

DETAILED DESCRIPTION

Described herein are compositions, methods and kits for modulating muscarinic receptor activity and treating diseases and disorders associated with muscarinic receptor activity. A bitopic muscarinic antagonist of muscarinic M₁, M₂, M₃, M₄ and M₅ receptors was discovered and is referred to herein as JB-D4. Structural analogs of JB-D4, as well as bitopic muscarinic agonists and analogs thereof, are also described herein.

JB-D4, a Bitopic Muscarinic Receptor Antagonist and Analogs Thereof

A careful examination of the structural features of JB-D4 (also referred to herein as “Compound A”), reveals the classical NCCOC backbone of acetylcholine, the ammonium head-group, and a region of negative electrostatic potential. Not wishing to be bound by theory, the ammonium head group is believed to interact with the orthosteric site of muscarinic receptors while the p-butoxybenzoyl linker is believed to interact with the allosteric site in a bitopic manner. JB-D4 can be generated or synthesized using any suitable methods. An example of a method of synthesizing JB-D4 is described below in Example 2.

JB-D4 has been shown to slow down dissociation of both the antagonist N-methyl scopolamine (NMS) and the agonist acetylcholine in kinetics experiments on cell lines stably transfected with M₁-M₅ muscarinic receptors. To probe the ability of JB-D4 to allosterically modulate orthosteric ligand, its effect on the rate of orthosteric radioligand dissociation has been investigated. In these experiments, a single concentration (0.1 mM and 1 mM) of JB-D4 has been tested for effects on the control [³H] NMS and [³H] acetylcholine dissociation rate at all M₁-M₅ mAChR, in full time course assays. The presence of JB-D4 has significantly slowed the dissociation rate of both [³H] NMS and [³H] acetylcholine from all M₁-M₅ receptors.

JB-D4 has been shown to slow down dissociation of NMS to the extent comparable with classical allosteric modulators like gallamine and alcuronium (Table 1, FIG. 2). These two modulators are neuromuscular blocking agents indicated as adjuncts to general anesthesia. The presence of JB-D4 (1 mM) has significantly slowed the dissociation rate of [³H]NMS from M₁ and M₂ receptors, K_(off) [hr⁻¹] 0.61±0.06 (control 1.10±0.06) and 1.19±0.03 (3.7±0.2) respectively, whereas JB-D4 substantially and significantly reduced dissociation rate from M₃, M₄ and M₅ receptors, K_(off) [hr⁻¹] 0.085±0.008 (control 0.57±0.03), 0.076±0.006 (control 0.54±0.020) and 0.083±0.005 (control 0.26±0.01), respectively.

TABLE 1 Dissociation of [³H] NMS control +0.1 mM JB-D4 +1 mM JB-D4 k_(off) [h⁻¹] k_(off1) [h⁻¹] f₂ [%] k_(off2) [h⁻¹] k_(off1) [h⁻¹] f₂ [%] k_(off2) [h⁻¹] M₁ 1.10 ± 0.06 0.91 ± 0.05 12 ± 1 1.15 ± 0.06 0.61 ± 0.06 M₂ 3.7 ± 0.2 2.8 ± 0.3 23 ± 2 3.2 ± 0.2 1.19 ± 0.03 12 ± 2 3.0 ± 0.4 M₃ 0.57 ± 0.03 0.41 ± 0.03 0.085 ± 0.008 M₄ 0.54 ± 0.02 0.38 ± 0.03 0.076 ± 0.006 M₅ 0.26 ± 0.01 0.18 ± 0.01  0.83 ± 0.005 Eq. 1 was fitted to the data from kinetic experiments. Data are means±SD from 3 independent experiments performed in quadruplicates. Equations: y=(100−f ₂)*e ^((−Koff1*X)) +f ₂ *e ^((−Koff2*X))  (Eq. 1)

where y is the percentage of radioligand binding at time x of radioligand binding at time 0, k_(off1) and k_(off2) are rate dissociation constants and f₂ is the percentage of sites with k_(off2) rate of dissociation. y=f*e ^((−Koff*X))  (Eq. 2)

where y is the percentage of radioligand binding at time x of radioligand binding at time 0, k_(off) is rate dissociation constant and f is percentage of sites with k_(off) rate of dissociation.

JB-D4 has been shown to slow down dissociation of acetylcholine dissociation stronger than those of gallamine and alcuronium (Table 2, FIG. 3). The presence of JB-D4 (1 mM) has significantly slowed the dissociation rate of [³H] acetylcholine from M₁ receptors, K_(off) [min⁻¹] 0.11±0.02 (control 0.30±0.02), whereas JB-D4 substantially and significantly reduced dissociation rate from M₂, M₃, M₄ and M₅ receptors, K_(off) [min⁻¹] 0.039±0.005 (control 0.97±0.06), 0.084±0.007 (control 0.40±0.03), 0.049±0.005 (control 0.38±0.02), 0.033±0.005 (control 0.11±0.01), respectively.

TABLE 2 Dissociation of [3H] Acetylcholine control +0.1 mM JB-D4 +1 mM JB-D4 f [%] k_(off) [min⁻¹] f [%] k_(off) [min⁻¹] f [%] k_(off) [min⁻¹] M₁ 89 ± 3 0.30 ± 0.02 90 ± 3 0.19 ± 0.02 88 ± 3 0.11 ± 0.02 M₂ 63 ± 3 0.97 ± 0.06 64 ± 4 0.56 ± 0.04 67 ± 3 0.039 ± 0.005 M₃ 85 ± 3 0.40 ± 0.03 84 ± 3 0.19 ± 0.02 82 ± 3 0.084 ± 0.007 M₄ 83 ± 3 0.38 ± 0.02 81 ± 4 0.18 ± 0.02 86 ± 3 0.049 ± 0.005 M₅ 82 ± 3 0.11 ± 0.01 81 ± 3 0.038 ± 0.05  81 ± 3 0.033 ± 0.005 Eq. 2 was fitted to the data from kinetic experiments. Data are means±SD from 3 independent experiments performed in quadruplicates.

JB-D4 has been shown to fully inhibit both QNB and NMS binding, in competition experiments (FIG. 4), at all M₁-M₅ muscarinic receptors, demonstrating the competitive nature of JB-D4 at orthosteric muscarinic binding sites. Order of potencies determined from IC₅₀ values: M₂>M₅=M₁>M₃>M₄ in competition with NMS and M₅>M₁>M₂>M₄>M₃ in competition with the antagonist QNB (Table 3). JB-D4 affects binding of muscarinic orthosteric ligands (agonist acetylcholine and antagonist NMS) in a competitive as well as allosteric manner. JB-D4 thus is a bitopic ligand.

TABLE 3 Inhibition of NMS and QNB Binding Competition with [³H]NMS IC_(50—)1 IC_(50 —)2 IC_(50—)3 avg IC₅₀ K_(D) NMS K_(I) rec [μM] [μM] [μM] [μM] SD [nM] [μM] M1 14.3 13.8 15.1 14.4 0.65574385 0.25 2.88 M2 3.31 3.37 3.45 3.37666667 0.07023769 0.37 0.91194647 M3 16.6 17.2 16.9 16.9 0.3 0.23 3.1601626 M4 43.4 42 40 41.8 1.70880075 0.22 7.53770492 M5 12.5 11.2 13.7 12.4666667 1.25033329 0.3 2.87692308 Competition with [³H]QNB IC_(50—)1 IC_(50—)2 IC_(50—)3 avg IC₅₀ K_(D) QNB K_(I) rec [μM] [μM] [μM] [μM] SD [nM] [μM] M1 8.72 9.42 8.19 8.77666667 0.61695489 0.134 1.0371017 M2 9.33 8.6 9.63 9.18666667 0.52974837 0.195 1.4990795 M3 39.5 20.6 28.16 29.42 9.51279139 0.173 4.33901108 M4 20.6 32.6 28.1 27.1 6.06217783 0.128 3.0751773 M5 5.73 6.76 7.34 6.61 0.81541401 0.143 0.82697288

JB-D4 may be used as a neuromuscular blocker with potencies comparable or greater to gallamine and alcuronium due to its bitopic nature. The much weaker allosteric effects of gallamine and alcuronium on acetylcholine kinetics may be associated to the smaller molecular size of acetylcholine compared to the much larger antagonists NMS or QNB. Both gallamine and alcuronium may leave a slit at the binding site opening, small enough for small agonists like acetylcholine to slip through. This, however, was not observed for JB-D4. Thus, JB-D4 and analogs thereof may find use in anesthesiology applications, e.g., in compositions for anesthetizing a subject.

JB-D4 has the potential to be an effective modulator for the treatment of OAB syndrome due to the fact that it significantly slows down both acetylcholine and NMS dissociation at M₃ receptors (Tables 1 and 2). The efficacy of antimuscarinic ligands in the treatment of OAB syndrome is believed to arise through inhibition of bladder M₃, and to a lesser extent M₂, muscarinic receptors on detrusor smooth muscle cells, urothelium and bladder afferent nerves. Experimental research has shown that for treatment of OAB, slow dissociation of antagonists from the M₃ receptor is more important than selectivity based on affinity. Therefore, M₃ antagonists are desirable agents for the symptomatic treatment of OAB. JB-D4 (1 mM) substantially and significantly reduced the dissociation rate of both NMS and acetylcholine from M₃ receptors, K_(off) (NMS) 0.085±0.008 (control 0.57±0.03) and K_(off) (Acetylcholine) 0.084±0.007 (0.40±0.03).

JB-D4 has the potential to be an effective M₅ antagonist for the treatment of drug addiction and withdrawal due to the fact that it significantly slows down both acetylcholine and NMS dissociation at M₅ receptors (Tables 1, 2). JB-D4 (1 mM) substantially and significantly reduced the dissociation rate of both NMS and acetylcholine from M₅ receptors, K_(off) (NMS) 0.083±0.005 (control 0.26±0.01) and K_(off) (acetylcholine) 0.033±0.005 (0.11±0.03). The areas of the brain associated with rewarding properties of opiate-based analgesic drugs contain M₅ receptors expressed in dopamine containing neurons of the ventral tegmental area (VTA). Since the VTA plays a dominant role in the rewarding system of the brain, it has been hypothesized that M₅ antagonists could reduce the pleasurable effects associated with such drugs. Therefore, the discovery of M₅ antagonists could be of great therapeutic value in the treatment and prevention of substance abuse.

Analogs and derivatives of JB-D4 are encompassed by the present invention. Examples of structural analogs of JB-D4 that are expected to display muscarinic bitopic properties similar to JB-D4 are shown as Compounds B-M in FIG. 1. To generate a JB-D4 analog or derivative, JB-D4 can be modified according to Schematic 1 below, for example. The interaction between receptor sites (allosteric/orthosteric) and ligand is optimized by varying R₁ and value of n. Schematic 2 below shows a structure for an analog as described herein having a 5-membered B-ring.

wherein:

-   R₁ is Me, Et, Pr, Bu, pentyl, or hexyl; -   R₂ is H or Me; -   X is C, O, or S;     -   Y is O, S or no group; -   W is C, O, N, or S -   Z is C, O, or S;     -   n is 1-5 CH₂-group; and -   m= is 0 or 1; and wherein -   the B-ring can be a 5 (m=0) or 6 (m=1)-membered saturated or     unsaturated ring containing one or more double bonds between any 2     carbon atoms and with W═C, O, N, or S at any position.

Some examples of analogs are described herein (e.g., Compounds B-M of FIG. 1). Analogs can be generated or synthesized using any suitable methods. Examples of methods of synthesizing JB-D4 and analogs thereof are described below in Examples 1 and 2. With regard to synthesizing JB-D4 analogs or derivatives, JB-D4 can be modified by replacing the four-carbon alkoxy group (R₁) with one to six-carbon linkages at the two, three and four position of the benzene ring (Compound B) with n (# of CH₂) equal to two, m=1 and W═CH₂. The piperidinyl ring is also replaced by a tetrahydropyridine group (Compound C). The position of the double bond is situated between any 2 carbon atoms of the tetrahydropyridine moiety. Furthermore, 6-membered rings with X (N, O, S) at any position of B-ring in place of any carbon atom is incorporated as well (Compound D). In all compounds, R₂ can either be a hydrogen or methyl group. These analogs of the invention may display similar muscarinic bitopic biological properties.

A second series of compounds is synthesized and tested for muscarinic binding and functional activity. In this series of compounds, the ester functionality is replaced by an ether or thio-linkage (Y═S, O) to improve metabolic stability and functional selectivity, Compounds E-G. Esters can be hydrolyzed by choline acetylcholine esterase, the enzyme that breaks down acetylcholine at synaptic gaps after neurotransmission. In all compounds, R₁ are one- to six-carbon alkoxy substituents and R₂ can either be a hydrogen or methyl group. These structural analogs of the invention may display similar muscarinic bitopic biological properties.

A third series of compounds is synthesized in which the classical NCCOC backbone of acetylcholine is partly incorporated within a cyclic dioxolane moiety, Compounds H-J. Either oxygen atom of the 1,3-dioxolane moiety can serve as the region of negative electrostatic potential. These compounds are also expected to be more resistant to enzymatic hydrolysis. In all compounds, R₁ are one- to six-carbon alkoxy substituents and R₂ can either be a hydrogen or methyl group. These structural analogs of the invention may display similar muscarinic bitopic biological properties.

A fourth series of compounds is synthesized in which the 3-alkoxy-1,2,5-thiadiazo moiety is coupled with morpholine, piperidine and tetrahydropyridine, Compounds K-M. In all compounds, R₁ are one- to six-carbon alkoxy substituents and R₂ can either be a hydrogen or methyl group. These structural analogs of the invention may display similar muscarinic bitopic biological properties.

Compositions for Modulating Muscarinic Receptor(s) Activity

Compositions for modulating muscarinic receptors include a bitopic muscarinic receptor antagonist or agonist, or analog or derivative thereof, as described herein. Typically, the composition includes a pharmaceutically acceptable carrier and a bitopic muscarinic antagonist or agonist having the formula:

wherein:

-   R₁ is Me, Et, Pr, Bu, pentyl, or hexyl; -   R₂ is H or Me; -   X is C, O, or S;     -   Y is O, S or no group; -   W is C, O, N, or S; -   Z is C, O, or S;     -   n is 1-5 CH₂-group; and -   m= is 0 or 1; and wherein     the B-ring can be a 5 (m=0) or 6 (m=1)-membered saturated or     unsaturated ring containing one or more double bonds between any 2     carbon atoms and with W═C, O, N, or S at any position, or an analog     or derivative thereof. The bitopic muscarinic antagonist or agonist     is in a therapeutically effective amount for activating or     inhibiting activation of at least one muscarinic receptor (e.g., one     or more of M₁, M₂, M₃, M₄ and M₅) in a subject. In a particular     embodiment, the composition includes a pharmaceutically acceptable     carrier and a bitopic muscarinic antagonist having the formula:

Compositions for use in anesthetizing a subject (e.g., a human in need thereof) will typically include a pharmaceutically acceptable carrier and a bitopic muscarinic antagonist that acts as a neuromuscular blocking agent. The bitopic muscarinic antagonist is in an amount effective to specifically activate M₃ and M₄ muscarinic receptors on smooth muscle tissues in the subject. An example of such a bitopic muscarinic antagonist is Compound A (JB-D4). However, suitable analogs or derivatives of Compound A may also be used.

The compositions described herein may be formulated for any suitable route of administration. Compositions may be administered orally, or parenterally by injection, infusion or implantation (subcutaneous, intravenous, intramuscular, intraperitoneal, or the like) in dosage forms, formulations, or via suitable delivery devices or implants containing conventional, non-toxic pharmaceutically acceptable carriers and adjuvants. The formulation and preparation of such compositions are well known to those skilled in the art of pharmaceutical formulation and may be formulated according to conventional pharmaceutical practice (see, e.g., Remington: The Science and Practice of Pharmacy (20th ed.), ed. A. R. Gennaro, Lippincott Williams & Wilkins, 2000 and Encyclopedia of Pharmaceutical Technology, eds. J. Swarbrick and J. C. Boylan, 1988-1999, Marcel Dekker, New York).

Compositions for parenteral use may be provided in unit dosage forms (e.g., in single-dose ampoules), or in vials containing several doses and in which a suitable preservative may be added (see below). The composition may be in the form of a solution, a suspension, an emulsion, an infusion device, or a delivery device for implantation, or it may be presented as a dry powder to be reconstituted with water or another suitable vehicle before use. Apart from the active agent that modulates activity of a muscarinic receptor(s), the composition may include suitable parenterally acceptable carriers and/or excipients. The active therapeutic agent(s) may be incorporated into microspheres, microcapsules, nanoparticles, liposomes, or the like for controlled release. Furthermore, the composition may include suspending, solubilizing, stabilizing, pH-adjusting agents, and/or dispersing agents.

As indicated above, compositions (e.g., pharmaceutical compositions) described herein may be in a form suitable for sterile injection. To prepare such a composition, the suitable active therapeutic(s) are dissolved or suspended in a parenterally acceptable liquid vehicle. Among acceptable vehicles and solvents that may be employed are water, water adjusted to a suitable pH by addition of an appropriate amount of hydrochloric acid, sodium hydroxide or a suitable buffer, 1,3-butanediol, Ringer's solution, and isotonic sodium chloride solution and dextrose solution. The aqueous formulation may also contain one or more preservatives (e.g., methyl, ethyl or n-propyl p-hydroxybenzoate). In cases where one of the compounds is only sparingly or slightly soluble in water, a dissolution enhancing or solubilizing agent can be added, or the solvent may include 10-60% w/w of propylene glycol or the like.

Materials for use in the preparation of microspheres and/or microcapsules are, e.g., biodegradable/bioerodible polymers such as polygalactin, poly-(isobutyl cyanoacrylate), poly(2-hydroxyethyl-L-glutam-nine) and, poly(lactic acid). Biocompatible carriers that may be used when formulating a controlled release parenteral formulation are carbohydrates (e.g., dextrans), proteins (e.g., albumin), lipoproteins, or antibodies. Materials for use in implants can be non-biodegradable (e.g., polydimethyl siloxane) or biodegradable (e.g., poly(caprolactone), poly(lactic acid), poly(glycolic acid) or poly(ortho esters) or combinations thereof). The bitopic muscarinic receptor agonists and antagonists described herein may be formulated as transdermal formulations, which may be administered using a variety of devices which have been described in the art (e.g., those described in U.S. Pat. Nos. 3,598,122, 3,598,123, 3,710,795, 3,731,683, 3,742,951, 3,814,097, 3,921,636, 3,972,995, 3,993,072, 3,993,073, 3,996,934, 4,031,894, 4,060,084, 4,069,307, 4,077,407, 4,201,211, 4,230,105, 4,292,299, and 4,292,303 each of which is hereby incorporated by reference in its entirety).

Formulations for oral use include tablets containing the active ingredient(s) (e.g., a bitopic muscarinic receptor agonist or antagonist or a derivative thereof) in a mixture with non-toxic pharmaceutically acceptable excipients. Such formulations are known to the skilled artisan. Excipients may be, for example, inert diluents or fillers (e.g., sucrose, sorbitol, sugar, mannitol, microcrystalline cellulose, starches such as potato starch, calcium carbonate, sodium chloride, lactose, calcium phosphate, calcium sulfate, or sodium phosphate); granulating and disintegrating agents (cellulose derivatives including microcrystalline cellulose, starches including potato starch, croscarmellose sodium, alginates, or alginic acid); binding agents (e.g., sucrose, glucose, sorbitol, acacia, alginic acid, sodium alginate, gelatin, starch, pregelatinized starch, microcrystalline cellulose, magnesium aluminum silicate, carboxymethylcellulose sodium, methylcellulose, hydroxypropyl methylcellulose, ethylcellulose, polyvinylpyrrolidone, or polyethylene glycol); and lubricating agents, glidants, and antiadhesives (e.g., magnesium stearate, zinc stearate, stearic acid, silicas, hydrogenated vegetable oils, or talc). Other pharmaceutically acceptable excipients can be colorants, flavoring agents, plasticizers, humectants, buffering agents, and the like.

The tablets may be uncoated or they may be coated by known techniques, optionally to delay disintegration and absorption in the gastrointestinal tract and thereby providing a sustained action over a longer period. The coating may be adapted to release the active drug in a predetermined pattern (e.g., in order to achieve a controlled release formulation) or it may be adapted not to release the active drug until after passage of the stomach (enteric coating). The coating may be a sugar coating, a film coating (e.g., based on hydroxypropyl methylcellulose, methylcellulose, methyl hydroxyethylcellulose, hydroxypropylcellulose, carboxymethylcellulose, acrylate copolymers, polyethylene glycols and/or polyvinylpyrrolidone), or an enteric coating (e.g., based on methacrylic acid copolymer, cellulose acetate phthalate, hydroxypropyl methylcellulose phthalate, hydroxypropyl methylcellulose acetate succinate, polyvinyl acetate phthalate, shellac, and/or ethylcellulose). Furthermore, a time delay material, such as, e.g., glyceryl monostearate or glyceryl distearate may be employed.

Optionally, a composition as described herein may be administered in combination with any other appropriate therapy; such methods are known to the skilled artisan and described in Remington: The Science and Practice of Pharmacy, supra. Combinations are expected to be advantageously synergistic. Therapeutic combinations that specifically activate or specifically inhibit activation of one or more muscarinic receptors are identified as useful in the methods described herein.

Methods of Treating a Disease or Disorder Associated with Activity of a Muscarinic Receptor

Described herein are methods of treating a disease or disorder associated with activity of a muscarinic receptor(s) in a subject. Typically the method includes administering to the subject a composition including a pharmaceutically acceptable carrier and a bitopic muscarinic antagonist or agonist having the formula:

wherein:

-   R₁ is Me, Et, Pr, Bu, pentyl, or hexyl; -   R₂ is H or Me; -   X is C, O, or S;

Y is O, S or no group;

-   W is C, O, N, or S; -   Z is C, O, or S;     -   n is 1-5 CH₂-group; and -   m= is 0 or 1; and wherein     the B-ring can be a 5 (m=0) or 6 (m=1) -membered saturated or     unsaturated ring containing one or more double bonds between any 2     carbon atoms and with W═C, O, N, or S at any position, or an analog     or derivative thereof. The bitopic muscarinic antagonist or agonist     is in a therapeutically effective amount for activating or     inhibiting activity of at least one muscarinic receptor in the     subject and alleviating or eliminating the disease or disorder in     the subject. In a typical embodiment, the subject is a human and the     disease or disorder is, for example, a CNS disorder (e.g.,     Parkinson's disease, Schizophrenia, AD, drug addiction and/or     withdrawal), OAB syndrome, COPD, or asthma. The composition can be     administered by any suitable route, e.g., orally or intravenously.

In one embodiment, in which the composition includes a bitopic muscarinic antagonist, administration of the composition results in inhibition of activation of at least one muscarinic receptor such as M₁, M₂, M₃, M₄, or M₅. In this embodiment, the bitopic muscarinic antagonist can be Compound A, for example. In one example, when used to treat drug addiction and withdrawal, the composition can include a bitopic muscarinic antagonist that specifically inhibits activation of M₅. In some embodiments, administration of the composition results in inhibition of activation of multiple muscarinic receptors (e.g., two or more of M₁, M₂, M₃, M₄, and M₅). For example, in anesthesiology applications, the bitopic muscarinic antagonist blocks activation of M₃ and M₄ muscarinic receptors. In another example, when used to treat OAB, the composition can include a bitopic muscarinic antagonist that specifically inhibits activation of M₃, and optionally, M₂.

In another embodiment, in which the composition includes a bitopic muscarinic agonist, administration of the composition results in activation of at least one muscarinic receptor such as M₁, M₂, M₃, M₄, or M₅. In this embodiment, the bitopic muscarinic agonist can be used for a number of neurological and psychiatric diseases including AD, Schizophrenia.

The therapeutic methods of the invention (which include prophylactic treatment) in general include administration of a therapeutically effective amount of a composition described herein to a subject in need thereof, including a mammal, particularly a human. Such treatment will be suitably administered to subjects, particularly humans, suffering from, having, susceptible to, or at risk for a disease, disorder, or symptom thereof. Determination of those subjects “at risk” can be made by any objective or subjective determination by a diagnostic test or opinion of a subject or health care provider (e.g., genetic test, enzyme or protein marker, genetic marker, family history, and the like).

The administration of a composition including a bitopic muscarinic antagonist or agonist, or a derivative thereof, for the treatment of a disease or disorder associated with activity of a muscarinic receptor(s) may be by any suitable means that results in a concentration of the therapeutic that, (e.g., in some embodiments, when combined with other components), is effective in inhibiting or promoting, respectively, activation of the muscarinic receptor(s). The bitopic muscarinic antagonist or agonist, or derivative thereof, may be contained in any appropriate amount in any suitable carrier substance, and is generally present in an amount of 1-95% by weight of the total weight of the composition. As described above, the composition may be administered locally or systemically (e.g., parenteral, orally, subcutaneously, intravenously, intramuscularly, or intraperitoneally).

In one embodiment, the invention provides a method of monitoring treatment progress. The method includes the step of determining a level of change in one or more suitable parameters or markers depending upon the disease or disorder being treated, using, for example, one or more diagnostic markers or diagnostic measurement (e.g., screen, assay) in a subject suffering from or susceptible to a disorder or symptoms thereof associated with activity of one or more muscarinic receptors in which the subject has been administered a therapeutic amount of a composition as described herein. The level of marker determined in the method can be compared to known levels of marker in either healthy normal controls or in other afflicted patients to establish the subject's disease status. In preferred embodiments, a second level of marker in the subject is determined at a time point later than the determination of the first level, and the two levels are compared to monitor the course of disease or the efficacy of the therapy. In certain preferred embodiments, a pre-treatment level of marker in the subject is determined prior to beginning treatment according to the methods described herein; this pre-treatment level of marker can then be compared to the level of marker in the subject after the treatment commences, to determine the efficacy of the treatment.

Methods of Anesthetizing a Subject

As described above, JB-D4 has the potential to be a neuromuscular blocker with potencies comparable or greater to gallamine and alcuronium due to its bitopic nature. JB-D4 has been shown to slow down dissociation of NMS to the extent comparable with gallamine and alcuronium (Table 1, FIG. 2) which are neuromuscular blocking agents indicated as adjuncts to general anesthesia. Thus, JB-D4 may be used as an adjunct in anesthesiology procedures. A typical method of anesthetizing a subject includes administering to the subject a composition including a pharmaceutically acceptable carrier or excipient and a bitopic muscarinic antagonist having the formula:

The bitopic muscarinic antagonist is in an amount (a concentration) effective for inhibiting activation of M₃ and M₄ muscarinic receptors on smooth muscle tissues in the subject (e.g. a human in need of anesthesia). Such a composition can further include an anesthesia agent. Examples of anesthesia agents include gallamine and alcuronium. In another embodiment, the composition can be administered with a second composition that includes an anesthesia agent. In this embodiment, the composition can be administered prior to, simultaneous to, or subsequent to administration of the second composition.

Effective Doses

The compositions described herein are preferably administered to an animal (e.g., rodent, human, non-human primates, canine, bovine, ovine, equine, feline, etc.) in an effective amount, that is, an amount capable of producing a desirable result in a treated subject (e.g., inhibiting or promoting activation of a specific muscarinic receptor(s) in the subject, anesthetizing a subject, etc.). Toxicity and therapeutic efficacy of the compositions utilized in methods of the invention can be determined by standard pharmaceutical procedures. As is well known in the medical and veterinary arts, dosage for any one animal depends on many factors, including the subject's size, body surface area, body weight, age, the particular composition to be administered, time and route of administration, general health, the clinical symptoms of the disease or disorder and other drugs being administered concurrently (if any). A composition as described herein is typically administered at a dosage that sufficiently inhibits or promotes activation of a specific muscarinic receptor(s) for treating, alleviating or preventing the diseases and disorders described herein or for anesthetizing a subject. As an example, a typical dose of JB-D4 for modulating activity (e.g., activation) of at least one muscarinic receptor in a subject is in the range of about 1 mg/day to about 1000 mg/day for a mammal. Such a dose is typically administered daily. However, depending on the subject and the disease or disorder being treated (or the anesthesia regimen), a dose may be administered multiple times a day, hourly, weekly, as-needed, etc.

Kits for Treating a Disease or Disorder Associated with Activity of a Muscarinic Receptor(s) in a Subject and for Anesthetizing a Subject

Described herein are kits for treating a disease or disorder associated with activity of a muscarinic receptor(s) in a subject and for anesthetizing a subject. A typical kit includes a composition including a therapeutically effective amount of a bitopic muscarinic antagonist or agonist, or a derivative thereof, for modulating activity (e.g., activation) of at least one muscarinic receptor in a subject, packaging, and instructions for use. In a kit, the composition may further include a pharmaceutically acceptable carrier in unit dosage form. If desired, a kit for anesthetizing a subject may also contain an effective amount of an additional anesthesia agent (e.g., gallamine, alcuronium, etc.). In some embodiments, the kit includes a sterile container which contains a therapeutic or prophylactic composition; such containers can be boxes, ampules, bottles, vials, tubes, bags, pouches, blister-packs, or other suitable container forms known in the art. Such containers can be made of plastic, glass, laminated paper, metal foil, or other materials suitable for holding medicaments.

EXAMPLES

The present invention is further illustrated by the following specific examples. The examples are provided for illustration only and should not be construed as limiting the scope of the invention in any way.

Example 1 Synthesis of JB-D4 and Structural Analogs

Method 1—p-alkoxy ester N-substituted piperidine and morpholine salts (Compounds B, D): Compound 1 is formed from the reaction of 2-bromoethanol with piperidine or morpholine. Compound 2 is obtained from the reaction of 1 with p-alkoxy benzoyl chloride in anhydrous ether. The corresponding hydrochloride and methyl iodide salts are obtained by reacting 2 with either HCl gas or methyl iodide, respectively.

Method 2—p-alkoxy ester N-substituted tetrahydro pyridine salts (Compound C): Compound 4 is formed from the reaction of 2-bromoethanol with pyridine. Compound 5 is obtained from the reduction of 4 with sodium borohydride. Reaction of 5 with p-alkoxy benzoyl chlorides in anhydrous ether yields compounds 6. The corresponding hydrochloride and methyl iodide salts 7 are obtained by reacting 6 with either HCl gas or methyl iodide, respectively.

Method 3—p-alkoxy ether and thioether N-substituted piperidine and morpholine salts (Compounds E, G): Reaction of morpholine or piperidine with 2-bromoethanol affords compounds 8. Reaction of compounds 8 with mesylchloride produces compounds 9. Reaction of compounds 9 with either p-alkoxyphenoxide or thio salts yields compounds 10. Reaction of compounds 10 with HCl or methyl iodide produces salts 11.

Method 4—p-alkoxy ether and thio ether N-substituted tetrahydro pyridine salts (Compound F): Reaction of pyridine with 2-bromoethanol affords compound 12. Reaction of compound 12 with sodium borohydride followed by mesylchloride produces compound 13. Reaction of compound 13 with either p-alkoxyphenoxide or thio salts yields compounds 14. Reaction of compounds 14 with HCl or MeI produce salts 15.

Method 5—p-alkoxy-1,3-dioxoxolane N-substituted piperidine and tetrahydro pyridine (Compounds H, I): Reaction of p-alkoxy benzaldehyde and 3-bromo-1,2-ethanediol can afford compound 16. Reaction of 16 with piperidine, followed by HCl gas or iodomethane can yield salts 17. Reaction of 16 with pyridine, followed by reduction with NaBH₄ and then HCl or iodomethane can produce salts 18.

Method 6—3-alkoxy-1,2,5-thiadiazo N-substituted tetrahydropyridine salts (Compound L): Oxidation of alcohol 5, followed by condensation with ammonium ion produces compound 20. Reaction of 20 with S₂Cl₂ provides compound 21. Reaction of 21 with an alcohol in the presence of sodium metal affords compound 22. Reaction of 22 with iodomethane or hydrogen chloride produces compounds 23.

Example 2 Synthesis of JB-D4

Route 1:

[2-Bromoethyl p-butoxybenzoate] To a 100-mL round bottom flask were added 2-bromoethanol (0.625 g, 0.005 mol), triethylamine (0.505 g, 0.005 mol) and 5 mL of dry anhydrous ether. The flask was cooled in an ice-bath and p-butoxybenzoylchloride (1.06 g, 0.005 mol) was added dropwise. The mixture was then refluxed for 30 minutes. The solution was filtered and 15 mL of 1M HCl was added to the filtrate. The mixture was extracted several times with water. The ether layer was dried over anhydrous magnesium sulfate, filtered and concentrated under vacuum to yield compound 1 (0.41 g, 27%). ¹H NMR (300 MHz, CDCl₃) δ 8.0 (2H), 7.0 (2H), 4.6 (2H), 4.2 (2H), 3.6 (2H), 1.8 (2H), 1.6 (2H), 1.0 (3H). MS: m/z 300 (M⁺), 121, 138 (base peak).

[2-(N-piperidine ethyl) p-butoxybenzoate]. Compound 1 (0.41 g, 0.00113 mol), 20 mL of acetonitrile, 1.0 g sodium carbonate and piperidine (0.116 g, 0.00113 mol) were added to a 100-mL boiling flask and left to stir overnight. The solution was filtered and concentrated under vacuum to yield 0.39 g of crude compound 2. The crude material was chromatographed over silica with a 10:1 mixture of CH₂Cl₂/MeOH to give compound 2 (0.36 g, 88%). ¹H NMR (300 MHz, CD₃COCD₃) δ 8.0 (2H), 7.1 (2H), 4.5 (2H), 4.2 (2H), 2.8 (2H), 2.6 (4H), 1.8 (2H), 1.6 (4H), 1.5 (2H), 1.0 (5H). MS: m/z 305 (M⁺), 165, 98, 138 (base peak).

[2-(N-piperidine ethyl) p-butoxy benzoylester N-methyl Iodide] (JB-D4) Compound 2 (0.36 g, 0.00118 mol) and 1 mL of iodomethane were added to a 25 mL boiling flask and stirred overnight. The mixture was concentrated to yield crude salt 3 (0.50 g, 63%). The salt was re-crystallized from n-butanol, m.p. 111-113° C. ¹H NMR (300 MHz, D₂O) δ 7.9 (2H), 7.0 (2H), 4.6 (2H), 4.1 (2H), 3.8 (2H), 3.5-3.3 (4H), 3.1 (3H), 1.9-1.8 (4H), 1.7-1.5 (4H), 1.45-1.35 (2H), 0.9-0.8 (3H). Anal. Calcd. For C₁₉H₃₀NO₃I: C, 51.03%; H, 6.71%; N, 3.13%; I, 28.38%. Found: C, 50.48%; H, 6.59%; N, 3.19%; I, 30.29%.

Route 2:

[N-(2-hydroxyethyl)piperidine]2-bromoethanol (1.40 g, 0.0112 mol), sodium carbonate (2.00 g, 0.019 mol) and 15 ml of acetonitrile were transferred to a 100 ml boiling flask. A mixture of piperidine (0.952 g, 0.0112 mol) in 5 mL of acetonitrile was added dropwise to the bromoethanol solution and stirred for two days at room temperature. The reaction mixture was filtered, concentrated and washed several times with anhydrous ether. The ether extracts were combined and concentrated to afford 0.53 gram of compound 1, a colorless liquid (36.8%). ¹H NMR (300 MHz, CDCl₃) δ 1.4-1.5 (2H), 1.5-1.65 (4H), 2.35-2.45 (4H), 2.45-2.5 (t, 2H), 3.25-3.35 (bs, 1H), 3.55-3.6 (t, 2H).

[2-(N-piperidine ethyl) p-butoxybenzoate hydrochloride]N-(2-hydroxyethyl)piperidine (1.05 g, 0.00815 mol), p-butoxybenzoyl chloride (1.7 g, 0.0080 mol) and 50 mL of anhydrous ether were added to a 100 mL boiling flask and stirred to form a white precipitate within minutes. The reaction mixture was concentrated and precipitate washed several times with anhydrous ether to afford 0.77 grams of compound 2 (28.2%). ¹H NMR (300 MHz, D₂O) δ 7.9 (2H), 6.9 (2H), 4.5 (2H), 4.0 (2H), 3.8 (2H), 3.6-3.2 (4H), 1.9-1.8 (4H), 1.7-1.5 (4H), 1.45-1.35 (2H), 0.9-0.8 (3H).

[2-(N-piperidine ethyl) p-butoxybenzoate] Compound 2 (0.77 g, 0.00226 mol) was neutralized with saturated aqueous sodium carbonate. The solution was extracted with ether and combined extracts was dried over anhydrous magnesium sulfate. The solution was filtered, filtrate was concentrated to afford 0.40 gram of compound 3 (58.8%). ¹H NMR (300 MHz, CD₃COCD₃) δ 8.0 (2H), 7.1 (2H), 4.5 (2H), 4.2 (2H), 2.8 (2H), 2.6 (4H), 1.8 (2H), 1.6 (4H), 1.5 (2H), 1.0 (5H). MS: m/z 305 (M⁺), 165, 98, 138 (base peak).

[2-(N-piperidine ethyl) p-butoxybenzoate N-methyl iodide] (JB-D4) Compound 3 (0.40 g, 0.00131 mol) was dissolved in 6 ml of HPLC-grade acetone and excess methyl iodide was added and the mixture stirred for four hours at room temperature. The reaction mixture was concentrated to afford 0.55 gram of compound 4 (94%), m.p. 108-110° C. Compound 4 was recrystallized from t-butyl alcohol to yield 0.311 gram (56.5%) of a white powder, m.p. 124-125° C. ¹H NMR (300 MHz, D₂O) δ 7.9 (2H), 7.0 (2H), 4.6 (2H), 4.1 (2H), 3.8 (2H), 3.5-3.3 (4H), 3.1 (3H), 1.9-1.8 (4H), 1.7-1.5 (4H), 1.45-1.35 (2H), 0.9-0.8 (3H). Anal. Calcd. For C₁₉H₃₀NO₃I: C, 51.03%; H, 6.71%; N, 3.13%; I, 28.38%. Found: C, 50.48%; H, 6.59%; N, 3.19%; I, 30.29%.

Other Embodiments

Any improvement may be made in part or all of the compositions, kits, and method steps. All references, including publications, patent applications, and patents, cited herein are hereby incorporated by reference. The use of any and all examples, or exemplary language (e.g., “such as”) provided herein, is intended to illuminate the invention and does not pose a limitation on the scope of the invention unless otherwise claimed. Any statement herein as to the nature or benefits of the invention or of the preferred embodiments is not intended to be limiting, and the appended claims should not be deemed to be limited by such statements. More generally, no language in the specification should be construed as indicating any non-claimed element as being essential to the practice of the invention. This invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or otherwise clearly contraindicated by context. 

What is claimed is:
 1. A composition comprising a pharmaceutically acceptable carrier and a bitopic muscarinic antagonist having the formula:

in a therapeutically effective amount for activating or inhibiting activation of at least one muscarinic receptor selected from the group consisting of: M₁, M₂, M₃, M₄ and M₅, in a subject.
 2. The composition of claim 1, wherein the composition is formulated for oral or intravenous administration.
 3. A kit comprising: (a) the composition of claim 1 in a therapeutically effective amount for activating or inhibiting activity of at least one muscarinic receptor in a subject; (b) instructions for use; and (c) packaging.
 4. The kit of claim 3, wherein the at least one muscarinic receptor is selected from the group consisting of: M₁, M₂, M₃, M₄, and M₅.
 5. The kit of claim 3, wherein the subject is a human.
 6. The kit of claim 3, wherein the composition is formulated for oral or intravenous administration. 